Darrell Kellus Pruitt, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13388 Issued in TX

Practice address

6737 Brentwood Stair Rd
#220
Fort Worth, TX 76112-3348

Phone

(817) 451-2323

Fax

(817) 451-1336

NPI assigned

Jan 14, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358121600000",
    "number": "1689911349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 BRENTWOOD STAIR RD",
            "address_2": "#220",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761123348",
            "telephone_number": "817-451-2323",
            "fax_number": "817-451-1336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6737 BRENTWOOD STAIR RD",
            "address_2": "#220",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761123348",
            "telephone_number": "817-451-2323",
            "fax_number": "817-451-1336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "DARRELL",
        "middle_name": "KELLUS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-14",
        "last_updated": "2013-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugene Douglas Provan, RPH
• Provectus Family Eye Care
• Provider Csao, LLC
• Provision Home Health
• Pruitt Chiropractic Clinic Hemphill, LLC (Pruitt Chiropractic Clinic)
• Laterica D. Pruitt, FNP
• Veronica Pruitt, LCSW-S
• Dary Prupes
• Antonia Reese Pryor, FNP-BC
• Kanika A Pryor

• General Practice Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.